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CONTEXT: Given the seemingly disparate nature of popular weight-loss diets (WLDs), consumers may have a difficult time choosing one. We hypothesized that because most of these diets differ greatly from the way most Americans spontaneously eat, the choice of a WLD may be less critical than the decision to adopt any WLD. OBJECTIVE: To assess the degree of similarity among several popular WLDs and that between average diets of Americans and the WLDs as a whole. DESIGN: One-day menus were randomly selected or constructed from 16 popular diet books (resulting in 17 distinct diets). Usual dietary intakes of individuals were derived from the Continuing Survey of Food Intakes by Individuals (CSFII) 1994-96, 1998. MAIN OUTCOME MEASURES: Euclidean distances, based on 12 dietary variables, were calculated among the popular WLDs, as well as between the WLDs and intakes from the CSFII. RESULTS: Euclidean distances among the WLDs ranged from 1.99 to 15.24, with a mean of 6.12 +/- 2.83. Mean distance between individuals' intakes from the CSFII and the closest WLD was 3.63 +/- 1.24, while the mean distance between individuals' intakes and the farthest WLD was 10.58 +/- 1.10. Mean distance between individuals' intakes and the WLDs considered together was 6.04 +/- 1.10. CONCLUSIONS: While the mean Euclidean distances between individuals' intakes and popular WLDs demonstrated meaningful differences, the differences among the WLDs were slightly greater and, in multivariate space, surrounded the diets consumed by Americans. This may have implications for the selection of a WLD in persons seeking to lose weight.

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OBJECTIVE: The objective was to examine the effect of offering a reimbursement incentive on the percentage of inquirers who enrolled in a weight control program and on weight loss and program attendance among enrollees. RESEARCH METHODS AND PROCEDURES: We used a sequential control-intervention design to observe how inquirers of the University of Alabama at Birmingham EatRight Lifestyle Program responded to an enrollment incentive for potential 50% ($150) reimbursement of the total program fee if they attended 10 of 12 classes and lost at least 6% of their current body weight. Inquirers had to be adults with a BMI >or=30 kg/m(2), seeking information about a weight control program, and informed of the program cost. Outcomes included proportion of inquirers enrolled, overall number of classes attended, and weight loss. RESULTS: Of the 401 people who inquired during the study periods, 24.5% and 25.0% enrolled in the intervention and control periods, respectively. There was a trend toward higher attendance in the intervention group, compared with the control group; there were no differences in percentage of weight loss. The odds of attending >or=10 classes were 2.4 times as high, and both losing >6% body weight and attending >or=10 classes were three times as high in the intervention subjects compared with controls, although non-significant. DISCUSSION: The potential of earning a performance-based reimbursement incentive did not affect enrollment in the EatRight Lifestyle Program. Performance-based incentives may be an ideal mechanism for extending coverage of weight-loss interventions by insurers because of limited financial risk and improved adherence.

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OBJECTIVE: The objective was to determine the role of physical activity (PA) and energy intake on weight maintenance among former University of Alabama at Birmingham EatRight Weight Management Program participants. RESEARCH METHODS AND PROCEDURES: Eighty-nine former participants completed follow-up visits > or =1 year after completing EatRight. BMI was calculated using measured height and weight. Diet intake was estimated from 4-day food records. PA was assessed using a module from the Behavioral Risk Factor Surveillance System Survey. Cut-off points were chosen based on the distribution of minutes of activity. For moderate and total activity, cut-off points were 0, 1 to 30, 31 to 60, and >60 minutes. For vigorous activity, the categories were 0, 1 to 20, 21 to 30, and >30 minutes. General linear models determined the association of PA with change in weight at follow-up controlling for gender and total energy intake (kcal/d). RESULTS: At follow-up, 80% (n = 71) of participants maintained (regained <5% of program end weight) their body weight and 20% had gained weight. Mean weight change was 1.0 +/- 6.5 kg. Maintainers consumed 384 fewer kcal/d on average. Maintainers had a lower energy density dietary pattern (1.58 vs. 2.01 kcal/g, p < 0.01). There was no significant difference in PA min/d reported by maintainers and gainers. DISCUSSION: Our results suggest that, despite being minimally active, weight-reduced individuals can successfully maintain their newly achieved body weight with appropriate caloric intake. Adopting a lower calorie, low energy density dietary pattern may reduce the amount of PA that is truly necessary for weight maintenance.

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OBJECTIVE: Observational study designed to determine weight outcomes and associated dietary intake patterns for a sample of participants > or =1 year after completing the University of Alabama at Birmingham EatRight Weight Management Program. RESEARCH METHODS AND PROCEDURES: Seventy-four former participants (64% women) completed follow-up visits > or =1 year after participating in EatRight, which promotes low-energy density, high-complex carbohydrate foods. Weight maintenance was defined as gaining <5% of body weight since completion of the EatRight program and staying below their program entry weight. Those who gained > or =5% of their body weight since completion were classified as gainers. RESULTS: During EatRight, participants of the follow-up study lost an average of 4.0 kg. After a mean follow-up time of 2.2 years, the average weight change was +0.59 kg (mean BMI, 32.5 kg/m(2)). Seventy-eight percent of participants gained <5% of their body weight; 46% had no weight regain or continued weight loss. Unadjusted mean intake for maintainers was 1608 kcal, whereas calorie intake for gainers was 1989 kcal. Despite eating slightly fewer calories (adjusted difference, 244; p = 0.058), maintainers ate a similar amount of food, resulting in a lower energy-density pattern (p = 0.016) compared with those who regained > or =5% of body weight. Gainers also reported consuming larger portions of several food groups. DISCUSSION: Our results indicate that low-energy-density eating habits are associated with long-term weight maintenance. Those who maintain weight after the EatRight program consume a low-energy-density dietary pattern and smaller portions of food groups potentially high in energy density than those who regain weight.

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CONTEXT: Carbohydrate-restricted diets have been popular in recent years. The theoretical glycemic impact of these diets, compared with other popular weight-loss diets, has not been reported. OBJECTIVE: To assess the glycemic index (GI) and glycemic load (GL) of 2 popular, carbohydrate-restricted diets (South Beach and Sugar Busters!) and compare them with a low-fat, high-carbohydrate diet (Ornish) and a moderate-fat, moderate-carbohydrate diet (EatRight). DESIGN: All available sample menus provided in the book for each diet were extracted and included in the analyses. GI values for all carbohydrate-containing foods were assigned based on a published list. GL values were determined based on these GI values and recommended serving sizes. MAIN OUTCOME MEASURES: Median daily GI and GL values were calculated for each diet and for each phase of South Beach and each meal pattern of EatRight. RESULTS: The median daily GLs of South Beach and Sugar Busters! (34 and 48, respectively) were less than one half those of Ornish and EatRight (113 and 104, respectively). Adjusting the diets to 1500 kcal attenuated the differences slightly. The median daily GIs of the diets were in a very narrow range (46-53); however, South Beach (46) was significantly lower than Ornish (53). CONCLUSIONS: The GLs of 2 carbohydrate-restricted diets were significantly lower than those of a low-fat, high-carbohydrate diet and a moderate-fat, moderate-carbohydrate diet. The differences were due primarily to lower carbohydrate content rather than to differences in overall GIs of the diets.

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